Unanticipated Gangrenous Cholecystitis in a Healthy Young Adult: A Case Report Highlighting the Role of Advanced Imaging

Background: Gangrenous cholecystitis (GC) is a severe form of acute cholecystitis, usually seen in patients with risk factors like advanced age or diabetes. This report highlights a rare case of GC in a young adult with no identifiable risk factors diagnosed by ultrasound and MRI. Case Presentation: A 22-year-old male with no significant medical history presented with a 20-day history of right hypochondrial pain and vomiting. Clinical examination revealed tenderness in the right upper quadrant with a positive Murphy's sign. Laboratory tests showed mildly elevated liver enzymes and inflammatory markers. Ultrasound and MRI indicated a distended, multi-lithiasic gallbladder with irregular thickened walls, presence of floating membranes in the vesicular lumen and discontinuous enhancement post-contrast administration. An urgent laparoscopic cholecystectomy confirmed severe inflammation and necrosis. Histopathology validated the diagnosis of gangrenous cholecystitis. Discussion: The imaging findings were consistent with known indicators of GC, including gallbladder wall thickening and intraluminal membranes. MRI provided critical diagnostic information. This case underscores the importance of considering GC even in young, healthy individuals. Conclusion: Advanced imaging techniques are crucial for the early diagnosis and management of gangrenous cholecystitis, significantly impacting patient outcomes through timely intervention.